Our Published Clinical Trial Shows Ketogenic Diet and Ketamine Infusions Effective in Anorexia
Groundbreaking. Exciting. And inviting a host of opportunities for more research, study, and clinical treatment on the efficacy of a ketogenic diet and ketamine for anorexia. Let’s start with the news and work backwards.
A therapeutic ketogenic diet, aimed to establish and maintain nutritional ketosis, but not weight loss, followed by ketamine infusion treatment is
safe
effective
and can provide symptomatic relief
in individuals with anorexia who are weight restored but continue to have
severe preoccupations with fears of weight gain,
body shape concerns and difficulties with self acceptance.
Calabrese, L., Scolnick, B., Zupec-Kania, B., Beckwith C., Costello K., Frank GKW. Ketogenic diet and ketamine infusion treatment to target chronic persistent eating disorder psychopathology in anorexia nervosa: a pilot study. Eat Weight Disord (2022). https://doi.org/10.1007/s40519-022-01455-x
[Altmetric: This article is in the 94th percentile (ranked 25,132nd) of the 433,108 tracked articles of a similar age in all journals and the 92nd percentile (ranked 3rd) of the 28 tracked articles of a similar age in Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity]
Anorexia nervosa is a complex condition that can be debilitating and sometimes fatal. The prevailing treatment protocols result in high rates of relapse and low recovery rates. There is no medication that has been shown to be effective. Even with extensive treatment, and even when weight is restored, many adults with anorexia have persistent fears of weight gain, consuming concerns with weight and body shape, food phobias, and chronic difficulties with self-acceptance.
These are the things that often lead to restriction and relapse, and interfere with recovery. They can persist for years, even in people with anorexia who are medically stable.
They’re stuck. In their thoughts and in their behaviors. With an “anorexic voice” that won’t shut up.
A Way Out
We have shown that using a ketogenic diet followed by a short series of ketamine infusions may offer a way out.
In an eating disorder world where patients are told that “all food is good food,” that they must eat and eat to regain the weight, sometimes they do. Sometimes they do regain the weight. But weight gain is not the only measure of recovery. For many with anorexia, the voice in their head — the anorexic voice — telling them they’re fat, they look disgusting, they can’t eat that, …. that voice never stops.
It never stopped for Caroline.
Even after 15 years, tens of thousands of dollars, hospitalizations, residential, partial and outpatient programs, dietitians, groups, therapy, and meds. After all the screaming, the fighting, the begging. After realizing she’d lost years, and opportunities. Even after she’d gained a little weight back and had a low normal BMI, even then, the eating disorder, the anorexic voice, the thoughts in her head, the behaviors, were all still there.
She began an incredible journey with the help of people who loved her and a ketogenic diet that was carefully designed to induce nutritional ketosis but not weight loss. And she started to get better. Then she came to me for ketamine treatment. And got well.
She Has Stayed Well for Three Years
She is not only in remission, she’s the poster child for remission from chronic severe anorexia using this novel sequenced treatment: a therapeutic ketogenic diet followed by ketamine infusions.
Remember Helen of Troy? With a face so beautiful it launched 1000 ships? Well… move over, Helen. Caroline of New York has a story so compelling that it has launched 12,000 views.
Read her backstory, or better yet, listen to an update of the whole story:
The story of how this one extraordinary young woman inspired a new treatment paradigm is something we’ll save for later. It’s a fascinating account of how a never-ending search for effective treatment unearthed research that spans the fields of evolutionary biology, preclinical animal models, electron microscopy and AgRP neurons, ketogenic neurochemistry, and a lone almost forgotten case series in England where ketamine infusions were used for anorexia. Let’s just say Barbara Scolnick MD poured over the journals, stayed up nights, gave up her weekends. I joined her.
As Caroline went into remission, and stayed in remission, we didn’t quite believe it, really. But her remission continued month after month after month. And so we decided to publish this extraordinary result in Frontiers in Psychiatry titled Remission from Chronic Anorexia with Ketogenic Diet and Ketamine: Case Report.
That one little case report generated interest (and some hate mail!) and has now been viewed more than 92% of all articles in Frontiers. We were shocked.
We wanted to see if this was real, if this novel approach to a deadly disorder could be a thing. Could a therapeutic ketogenic diet and ketamine infusions be used safely in other adults with anorexia, and could their persistent eating disorder thoughts and patterns also stop?
We wanted to see if we could replicate the result and generate research interest in this novel approach to anorexia.
So we designed a small clinical trial, registered it on clinicaltrials.gov, got IRB approval, and recruited adults with chronic anorexia who were partially weight restored. Then we ran the study during the height of the COVID pandemic.
Who Does This?
Answer: Women with a passion, with a deep drive to search and to know — women who are relentless — do things like this.
We got hate mail. Presented our hypothesis, our case report, and our clinical trial idea to eating disorder specialists, dietitians, colleagues, and therapists. Talked to program directors, hospital directors. Stakeholders. Scientists.
More hate mail. Talking diet, or keto, in the eating disorder world is like saying a 4-letter word.
But then an extraordinary thing happened: the study participants started to get better.
The clinical trial concluded, the follow-up began, and the data analysis started. (Thank goodness for espresso.) We presented our preliminary results in Oxford, UK at the prestigious Ketamine and Related Compounds for Psychiatric Disorders 2022: An International Hybrid Conference in April just as air travel started to open up.
The study has now been peer-reviewed and was just published. It’s open-access which means that anyone can find it easily and read it. You don’t have to pay for access or get it from a university library. You can read the study here.
We were honored to present this at the XXVIIIth Annual Meeting of the Eating Disorder Research Society Annual Meeting in Philadelphia in September 2022. The theme of the meeting was The Next Generation of Eating Disorder Research: Breakthroughs, Innovations, and Future Directions. How fitting! And we’re about to present it at the 2023 International Conference on Eating Disorders in Washington DC on June 2023.
If you’d like to see if you might be a candidate for this kind of ground-breaking approach, please contact us.
We’d love to help you get back to your best self.